Dear Dr. Garner,
While most people dread hay fever in the springtime, I dread gout. I have been suffering from flare-ups every March for the past 10 years.
I remember my grandparents always talking about how their arthritis came on due to changes in the weather. Could this be something like what I am experiencing with gout? And why should the spring make it worse? I don’t do anything different.
Thank you for any advice you might have.
Springtime Gout in Sunnyside
Dear Springtime Gout,
Gout, also known as podagra when it involves the big toe, is a medical condition with recurrent attacks of joint pain. The joint is often red, tender, hot and swollen. The big toe region is the most commonly affected area in about 50 percent of the cases. The diagnosis is made by withdrawing fluid from the joint and seeing the characteristic crystals that are in the fluid.
Gout was historically known as the disease of kings or a rich man’s disease because of the food and alcohol available to the rich. In recent decades, it has become more common, affecting one to two percent of our population.
You described something that is very common – namely that gout causes flare-ups in March and April. Unfortunately, I could find no explanation in the medical research world to explain this.
I was also talking about this with my brother and noted rheumatologist Dr. Bruce Garner.
Reports of the possible effect of weather conditions on gout go back to at least 1920. Some studies showed that gout was prevalent in the springtime. One study done in Chicago showed 40 percent of the gout flare-ups appeared in the spring. Similar findings have occurred in Israel and Philadelphia.
Gout is a very painful type of arthritis. It has been increasing in numbers lately. This may be due to diet and lifestyle changes and also new medications that cause increased levels of uric acid. Gout occurs when there is too much uric acid in the body. This can occur in one of two ways: Either the chemical (uric acid) can come from foods that we eat (in excess), or it can be manufactured within human cells in a way that is faulty and makes too much.
In addition to gout, high uric acid levels are also associated with kidney stones.
Gout may be treated with a daily, oral medication which helps to slow down the body’s production of uric acid. Anti-inflammatory medication such as Motrin may be taken for acute attacks and pain.
People with more than two or three attacks of gout in the past year, unusually severe attacks of gout, evidence of joint damage or elevated levels of uric acid should be on long-term treatment.
The medication most people use is allopurinol, which is taken by mouth once a day. It also has a good effect in lowering the bad cholesterol level in the body.
Foods to avoid include organ meats such as liver, kidney, sweetbread and meat extract in soup or gravy. Seafood to avoid include anchovies, sardines, herring, canned tuna, shrimp, scallops and muscles. As far as vegetables, avoid peas, asparagus and spinach. Crash dieting should be avoided as the alternating weight loss and gain may cause acute attacks.
Drink plenty of water and non-alcoholic beverages to remove the uric crystals from the body. Alcohol should be avoided since it promotes uric acid production. It is wise to avoid activities that have repetitive joint trauma.
It is also suggested not to wear tight shoes as this can cause acute joint injury and possible stimulation of gouty attacks.
Drinking coffee, vitamin C and dairy products appear to decrease the risk of gout. In some cases, it is inherited, and it is just the luck of the draw.
Gout often occurs in combination with other medical problems, and there are certain medications that have been associated with gout.
It is critical to treat gout, so visit your doctor and continue to watch your intake of food and alcohol and keep your weight in good control.[hr] Dr. Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on The NET, Tuesdays at 8 p.m. on Channel 97 Time Warner and Channel 30 Cablevision.